Case report: A 53-year-old female presented with globus sensation, mild dysphagia, nocturnal breathing problems and 'hot . Ekstrom-Smedby K. Epidemiology and etiology of non-Hodgkin lymphoma--a review. PubMed His CT and MRI scans found only thickness of the oropharyngeal wall and epiglottal folds, and a superficial biopsy revealed only inflammation. Guastafierro S, Falcone U, Celentano M, Cappabianca S, Giudice A, Colella G. Primary mantle-cell non-Hodgkin's lymphoma of the tongue. Fluorescence in situ hybridization (FISH) analysis using Break Apart FISH Probes was used to detect BCL2, BCL6 and cMYC gene rearrangements. In addition, an understanding of these diseases will allow the development of new targeted therapies for these aggressive lymphomas. Radiol Clin North Am. The tissue demonstrates a polarized mantle zone beneath a somewhat attenuated epithelium. The objective of the present study was to identify severe HBT cases and their symptoms and to correlate them with the presence of pharyngolaryngeal signs and esophageal symptoms of gastroesophageal reflux (GER) in patients seen at a laryngology clinic. She started rituximab-CHOP(R-CHOP) regimen. An official website of the United States government. Asian Pac J Cancer Prev. Except in one case of four, all of our patients were alive through follow-up. Only one patient died of the disease. Hans CP, Weisenburger DD, Greiner TC, Gascoyne RD, Delabie J, Ott G, Muller-Hermelink HK, Campo E, Braziel RM, Jaffe ES, Pan Z, Farinha P, Smith LM, et al. In addition, patients may notice irregularities on their own, thereby bringing the appearance to the attention of their dentists or hygienists. Lymphoid hyperplasia at the base of the tongue. https://doi.org/10.22034/APJCP.2017.18.10.2781. Mamede RC, Amaral Fd, Raimundo DG, Freitas LC, Ricz HM, Mello Filho FV. Two pathologists interpreted the FISH results using an Olympus fluorescence microscope equipped with 100 objective lens and orange/ green/4, 6-diamid-ino-2-phenylindole filters. Clinicopathological information including age, gender, tumour location, histological subtype, grading, staging, survival, and response to treatment was acquired from the archives. PMC Understanding the biological behavior of and therapeutic options for tongue lymphoma is difficult due to the paucity of cases. government site. Cytoplasmic staining was used for ALK, TIA, AE1/AE3. Improved survival of patients with human papillomavirus-positive head and neck squamous cell carcinoma in a prospective clinical trial. 2006;30:85967. This is consistent with the findings from 17 DLBCL cases reported by Owosho AA et al. Epub 2009 Jun 26. https://doi.org/10.1016/j.ijom.2004.08.009. To the best of our knowledge, four cases have been reported, including our case and three cases from literature (Table 5) [17, 27, 40]. Chi HS, Lee KW, Chiang FY, Tai CF, Wang LF, Yang SF, Lin SF, Kuo WR. Here we present a literature review and case series of seven patients with NHL of the tongue base. Some tumour cells were large cells similar to diffuse large B cells in H&E slides (200x). Paracortical hyperplasia may be accompanied by vascular proliferation. Vega F, Lin P, Medeiros LJ. Shimada K. Molecular pathogenesis and treatment strategy in diffuse large B-cell lymphoma. Braz J Otorhinolaryngol. This paper describes a case where a patient diagnosed with tongue base lymphoid hyperplasia was successfully treated with radiofrequency excision and interstitial radiofrequency-induced thermotherapy. Imaging and pathological findings of PTCL (case 3). Cancer. The tumour cells were large and blastic, with a high mitotic rate, which was similar to diffuse large B lymphoma tumour cells. The HPV subtype that often infected the cervix, were active but doesnt do much harm to the host because the oral area was not the best breeding site for the virus. https://doi.org/10.1016/j.oooo.2014.06.002. A final diagnosis was made through deep resection. 1, pp. Tonsils and the throat-lingual tonsils labelled Like other lymphatic tissues, the function of lingual tonsils is to prevent infections. The lingual tonsil is located at the base of the tongue and related to circumvallate papillae, whereas subepithelial lymphoid tissue at the posterior lateral portion of the tongue and related to foliate papillae constitutes the lateral lingual tonsil. Nathu RM, Mendenhall NP, Almasri NM, Lynch JW. Nancy W. Burkhart, EdD, BSDH, AFAAOM, is an adjunct associate professor in the Department of Periodontics-Stomatology, College of Dentistry, Texas A&M University, Dallas, Texas. .. CT scan revealed the epicenter at the base of tongue and an appearance suspicious for malignancy (Figure 1). Extranodal lymphomas of the head and neck. 2012 May 28;18(20):2462-71. doi: 10.3748/wjg.v18.i20.2462. 1),and two cases expressed c-Myc(>40%). B. C. Jham, N. O. Binmadi, M. A. Scheper et al., Follicular lymphoid hyperplasia of the palate: case report and literature review, Journal of Cranio-Maxillofacial Surgery, vol. https://doi.org/10.1016/S0344-0338(11)80514-5. Connect with a U.S. board-certified doctor by text or video anytime, anywhere. Patient ages ranged from the thirties to the nineties, with an average age of 61.8years. M. Samoszuk, E. Ramzi, and J. Ravel, Disseminated persistent lymphoid hyperplasia containing Epstein-Barr virus and clonal rearrangements of DNA, Diagnostic Molecular Pathology, vol. Cases of PTCL and MCL are described in detail in the Results section. Lymphoid hyperplasia of the tongue is a very rare benign lymphoproliferative lesion that closely resembles carcinoma or lymphoma, clinically or histopathologically. Parkin DM, Bray F, Ferlay J, Pisani P. Estimating the world cancer burden: Globocan 2000. Two probes (EBV and HPV) were used for all seven cases. MCL usually express CD5 and CyclinD1 protein. Domanski HA, Akerman M. Fine-needle aspiration cytology of tongue swellings: a study of 75 cases. Pribuisiene R, Uloza V, Siupsinskiene N, Butkus E, Kupcinskas L. Al-Asoom L, Al-Rubaish AM, El-Munshid HA, Al-Nafaie AN, Bukharie HA, Abdulrahman IS. Our attention is especially drawn to areas where increased gingival growth is uncommon, such as the soft palate, uvula, and posterior oropharynx. J Laryngol Otol. Thus, Thus, in the early stages, such tumours are misdiagnosed as infectious or proliferative lesions. A poor prognostic case of peripheral T-cell lymphoma in the base of tongue with chemotherapy followed by radiation therapy. Histological features include distention or engorgement of both subcapsular and intraparenchymal sinuses by benign histiocytes which may be hemophagocytic. Educational text answers on HealthTap are not intended for individual diagnosis, treatment or prescription. Lymphoid hyperplasia of the tongue is a very rare benign lymphoproliferative lesion that closely resembles carcinoma or lymphoma, clinically or histopathologically. The same study also showed that lymphoma at this site is always early stage [21, 24]. The lymphoid follicles at the base of the tongue can be detected when examining the pharynx of adults, but the presence of large follicles, denoted "severe" hypertrophy of the base of the tongue (HBT) is rare. For the in situ detection of high-risk HPV integration at the mRNA level, the RNAscope FFPE 2.5 HD detection kit (Brown) (CAT #322310) was used according to the manufacturers instructions. The biopsy diagnosis was peripheral T-cell lymphoma. Unable to load your collection due to an error, Unable to load your delegates due to an error. J Clin Oncol. The tongue has a rich network of lymphatics that drain to neck levels I-III, which is the usual pattern of spread when these tumors metastasize. The DLBCL, NOS cases were further divided into GC and NGC B cell like subtypes based on immunohistochemical expression of CD10, Bcl-6 and Mum1 [11]. Asano N, Suzuki R, Kagami Y, Ishida F, Kitamura K, Fukutani H, Morishima Y, Takeuchi K, Nakamura S. Clinicopathologic and prognostic significance of cytotoxic molecule expression in nodal peripheral T-cell lymphoma, unspecified. An abstract is unavailable. Microorganisms that are regularly associated with the development of NHL include EBV, HIV,etc. In our case, the late stage of disease, the morphologically blastic variant [44], and involvement of neck lymph nodes were all factors that contributed to poor prognosis of this patient. Benign Lymphoid Hyperplasia of the Tongue Base Causing Upper Airway Obstruction Severe benign lymphoid hyperplasia (LH) is unusual in the head and neck region, but the diagnosis of LH is of clinical importance as it may be confused with malignant lymphoma, both on clinical examination and pathologically. Mantle cell lymphoma: 2012 update on diagnosis, risk-stratification, and clinical management. These tissues act as your body's first line of defense against infections. All these factors might explain why the patient survived only 3months after diagnosis although he was in an early stage and had a low IPI score. This article is available as a PDF only. Sun J, Lu Z, Yang D, Chen J. 2006;45:25871. The blastic variant of mantle cell lymphoma arising in Waldeyer's tonsillar ring. The patient received two cycles of GDP (gemcitabine, dexamethasone, cisplatin) and seven cycles of CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) chemotherapy. Primary intestinal T-cell and NK-cell lymphomas: a clinicopathological and molecular study from China focused on type II enteropathy-associated T-cell lymphoma and primary intestinal NK-cell lymphoma. 2000;21:2716. 2, no. Baran et al. Peripheral T-cell lymphoma mimicking marginal zone B-cell lymphoma. There was no cervical adenopathy, and CT of the thorax and abdomen was negative. Aggregates of lymphoid tissue are all over the oral mucosa, but they are often prominent in the soft palate, uvula, and pharynx. Epub 2018 Jun 25. Does lymphoid hyperplasia and Lymphoma looks the same and is there a threatment for oral Lymphoid Hyperplasia? A mass was identified in the right base of the tongue that caused breathing difficulties. Vose JM. Increasingly, cancers at the base of the tongue are . 4, pp. or a reactive lymphoid proliferation to an unknown antigenic stimulation [2]. Part of Lymphoid hyperplasia is a rapid increase in the number of normal cells (called lymphocytes) that are contained in lymph nodes. The most common histologic subtype was diffuse large B-cell lymphoma (DLBCL), which occurred in five cases. Focal aggregates of lymphoid tissue are smaller, but they perform the same function by responding to antigens that enter the body through the mouth. While the etiology is poorly understood, a number of previous theories exist, which are included here in the context of a literature review. What are the symptoms and prognosis for a benign reactive lymphoid hyperplasia of the neck lymph node? Methods We reported a severe case of tongue base BLH compromising the breathing and swallowing of the affected patient. HHS Vulnerability Disclosure, Help https://doi.org/10.1016/j.ijom.2010.03.029. Review of the preoperative anaesthesia records revealed no features of airway obstruction nor B symptoms on clinical history. 2000;113:5128. HPV RNA ISH all negative. Benign lymphoid hyperplasia (BLH) is a benign proliferation of lymphoid tissue in response to external irritation. https://www.linkedin.com/showcase/4000114/. St. Louis, MO: Elsevier; 2016. A clinical note. 2. Four were staged at III and IV and had higher IPI scores (2 or 3). c. Tumour cell infiltrated squamous epithelium (400x). The role of EBV in the pathogenesis of diffuse large B cell lymphoma. 2012;87:6049. J Natl Cancer Inst. Google Scholar. Confirmation of the molecular classification of diffuse large B-cell lymphoma by immunohistochemistry using a tissue microarray. https://doi.org/10.2214/ajr.149.3.575. Patients first experienced from varying degrees of throat discomfort and commit to the hospital with no B symptoms. 8600 Rockville Pike Diagn Pathol 15, 30 (2020). [2], Follicular hyperplasia is a stimulation of the B cell compartment. ENT manifestations of gastroesophageal reflux. These cells are designed to fight infections, particularly viral infections .. Almost all cancers in the base of the tongue are squamous cell carcinomas, which form in the thin, flat cells that line the larynx. The number of cases in the present study was low, so further studies will be needed to better understand the relationship between HPV infection and lymphoma of the base of the tongue. 1998;112:9914. In the orofacial region, RLH most often occurs in the oropharynx, Waldeyers tonsillar ring, the soft palate, the lateral tongue, and the floor of the mouth.2 Waldeyers ring includes the lingual and palatine tonsils, the adenoids, lymphoid follicles located on the posterolateral tongue in the area of the foliate papillae, and level 1 lymph nodes in the floor of the mouth. 4 Metrics Downloaded 279 times PDF download Lee ES, Kim LH, Abdullah WA, Peh SC. Postoperatively the patient was deemed unsafe for extubation and transferred to the intensive care unit while placed on high-dose intravenous dexamethasone. [2] Lymph node anatomy [ edit] Singh T, Amirtham U, Satheesh CT, Sajeevan KV, Jain A, Lakshmaiah KC, Babu KG, Lokanatha D. Primary B cell non-Hodgkin's lymphoma of tongue. e. Tumour cells were positive for CD4 (200x). Mod Pathol. All authors read and approved the final manuscript. 2005;9:34050. Feinberg SM, Ou SH, Gu M, Shibuya TY. Oral Surg Oral Med Oral Pathol Oral Radiol. 2, pp. Lee JT, Paquette R, Sercarz JA, Wang MB. PTCL, NOS occurring at the base of the tongue are rare. 2005;29:128493. https://doi.org/10.1080/02841860500531682. This is consistent with head and neck research findings [6, 26]. Four treatment response classes were defined, as follows: complete response (CR, 100% resolution); partial response (PR, 50100% resolution); no response (<50% resolution); and progression of disease (PD, tumour enlarged after treatment). Would you like email updates of new search results? government site. Three patients are alive with disease and 2 are alive without disease. Yuen A, Jacobs C. Lymphomas of the head and neck. The exceptional case here was a 45-year-old male patient with diffuse large B cell lymphoma who presented with only deep painful mouth ulcers and general symptoms, including sore throat, choking when drinking water, and difficulty swallowing. A minority of patients develop local recurrence. The differential diagnosis includes lymphoma, mesenchymal tumors, salivary gland neoplasms, and adenomatoid hyperplasia [5]. 2013 Dec;137(12):1837-42. doi: 10.5858/arpa.2012-0678-RS. Benign lymphoid hyperplasia is a benign proliferation of lymphoid tissue in response to external irritation and occurrence within oral cavity is rare. The tumour cell composition of MCL varies greatly in the literature, from small cells with slightly irregular nuclei to large cells similar to the large cells in DLBCL, which could be misdiagnosed as DLBCL. Our HPV-infected patient indeed had a favourable prognosis, and he was alive and free of disease when this manuscript was prepared (68months). The most common site for all cases was at the base of the tongue. 8600 Rockville Pike 2023 BioMed Central Ltd unless otherwise stated. Semin Oncol. Please enable it to take advantage of the complete set of features! d. Tumour cells were positive for C-myc (200 x). Studies on the survival time for patients with DLBCL in the head and neck are controversial [24, 36, 37]; here, we added that lymphoma arising from the base of the tongue has a good prognosis. Imaging examination can help identify lesions. For NHL of the head and neck, there is a logarithmic increase in incidence with increasing age [18] .The average age at disease diagnosis was 61.8years and there were no observed gender differences. The follow-up period started from the date of diagnosis until August 30, 2019, and ranged from 3 to 90months. 1, pp. f. Ki-67 staining of the tumour cells (200x). Lymphoid Hyperplasia i was referred to ENT by my GP because of a recurring sore throat. Would you like email updates of new search results? The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Globus pharyngeus: a review of etiology, diagnostics, and treatment. Among our cases, there were 1 GC and 3 NGC cases. Surgical debulking/excision is the treatment of choice. The biopsy showed recurrence, with bone marrow involvement. Three out of four cases had a high Ki-67 index. As seen in Figure 1, the soft palate, uvula, and posterior pharynx demonstrate multiple areas of enlargement that are consistent with lymphoid tissue. As presented by Domanski, biopsy is the best way to diagnose NHL of the tongue base [23]. Cancer at the base of the tongue is usually diagnosed at an advanced stage, when the tumor is larger and the cancer has spread into the lymph nodes in the neck. Mamede RC, De Mello-Filho FV, Vigrio LC, Dantas RO. Primary diffuse large B-cell lymphoma of the ovary is of a germinal Centre B-cell-like phenotype. Doctors typically provide answers within 24 hours. Sun J, Zhang J, Ling Q, Luo Y, Wu S, Liang Z, Zhong D, Zeng X. Synchronous cancers in patients with head and neck cancer: risks in the era of human papillomavirus-associated oropharyngeal cancer. Is it always necessary to carry out a biopsy on lymphoid hyperplasia or is endoscopic examination and MRI enough to decide that it is benign? 2023 Endeavor Business Media, LLC. FOIA Maheshwari GK, Baboo HA, Gopal U, Wadhwa MK. https://doi.org/10.1007/s00428-014-1682-7. Squamous cell hyperplasia in the oral cavity is seen most commonly on the tongue, palate, and lateral wall of the pharynx. Positive staining was indicated by brown punctate dots in the cytoplasm. Under the microscope, normal tissue was replaced by diffuse large atypical lymphocytes with relatively abundant cytoplasm. 1999;21:24754. Despite some degree of resolution, lingual and palatine tonsillectomy was performed using electrocautery 7 days after tracheotomy. Globus pharyngeus: a review of its etiology, diagnosis and treatment. CAS Cut-off values were set as previously described [9]. 1979 Sep;30(5):485-8. doi: 10.1016/s0009-9260(79)80176-2. SW and XZ did the BCL-2, BCL-6, c-MYC FISH examination. A case of benign. Clinical images of entities may be beneficial for documentation purposes, as they may be viewed during future appointments should there be recurrences. Diffuse large B-cell lymphoma and mantle cell lymphoma of the ocular adnexal region, and lymphoma of the lacrimal gland: an investigation of clinical and histopathological features. Arch Pathol Lab Med. Never disregard or delay professional medical advice in person because of anything on HealthTap. The outer cortex is composed of follicles of B cells so that it is called the B-cell zone. Lewis JS Jr. Morphologic diversity in human papillomavirus-related oropharyngeal squamous cell carcinoma: catch me if you can! Imaging and pathological findings of DLBCL (case 5). National Library of Medicine Before Sirsath NT, Lakshmaiah KC, Das U, Lokanatha D, Chennagiri SP, Ramarao C. Primary extranodal non-Hodgkin's lymphoma of oral cavity--a single Centre retrospective study. 18, no. 2013;119:18327. XS and QL did the HPV ISH. Six of the cases exhibited tongue base masses with smooth surface membranes. The biological behaviours that are exclusive to the tongue base are not clear. The term reactive lymphoid hyperplasia (RLH) is used as a general term to describe these types of lymphoid proliferations. The patient was kept on a three-week course of tapering prednisone and proton-pump inhibitors. The airway was subsequently secured, and the procedure was undertaken. Radiology. 2017;18:27815. 2004;103:27582. Not applicable. The site is secure. One patient in the literature died 17months after diagnosis. The .gov means its official. Pseudotumours of the oropharynx due to muscular contraction. Otolaryngologic manifestations of gastroesophageal reflux. One of the DLBCL cases was positive for HPV DNA and diffusely expressed P16 protein. https://doi.org/10.4103/0019-509X.58873. When the lymphoid tissue is deeply seated, the appearance may be more pink or deeper in color. Lymphoid hyperplasia is not a disease or a tumor, but simply a term we use to represent enlarged tissue masses. All authors read and approved the final manuscript. AJR Am J Roentgenol. Dysphagia. 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